Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview

• Published in: Journal of clinical epidemiology Vol. 96; pp. 110 - 119
• Main Authors: Smit, Linda C., Schuurmans, Marieke J., Blom, Jeanet W., Fabbricotti, Isabelle N., Jansen, Aaltje P.D., Kempen, Gertrudis I.J.M., Koopmans, Raymond, Looman, Willemijn M., Melis, Rene J.F., Metzelthin, Silke F., Moll van Charante, Eric P., Muntinga, Maaike E., Ruikes, Franca G.H., Spoorenberg, Sophie L.W., Suijker, Jacqueline J., Wynia, Klaske, Gussekloo, Jacobijn, De Wit, Niek J., Bleijenberg, Nienke
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018; Elsevier Limited
• Subjects: Adults; Black boxes; Complex interventions; Development; Epidemiology; Evaluation; Fidelity; Frailty; Improvement; Medicaid; Modelling; Older people; Primary-care programs; Studies; Systematic overview; Training; Netherlands; Development; Evaluation; Improvement; Systematic overview; Primary-care programs; Complex interventions
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2017.12.013

Complex interventions are criticized for being a “black box”, which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions. A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands. There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists. An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions.